Real-World Efficacy of 1064-nm Nd:YAG Laser for the Treatment of Onychomycosis.

Background: Onychomycosis is a cosmetic and, at times, medical concern; therefore, effective and safe alternatives to treatment are needed. Objective: To determine the efficacy of a 1064-nm Nd: YAG laser for the treatment of onychomycosis in a real-world setting. Methods: A single-centre retrospective chart review was conducted between 2012 and 2013. One hundred consecutive patients with a culture-and/or potassium hydroxide-confirmed diagnosis of onychomycosis were treated at least twice. Baseline and follow-up photographs were taken, and the change in degree of clinical nail involvement of the subject's great toenail was determined by a blinded reviewer using validated planimetry measurement. Results: A total of 199 hallux nails from 100 subjects were assessed. The mean infected area decreased from 53.2% at baseline to 50.8% at the end of the study (paired t test, P = .054; Wilcoxon signed rank test, P = .006). Degree of nail involvement was statistically significantly associated with amount of improvement; subjects who had the greatest degree of nail involvement improved the most, while those with less severe disease showed a worsening of nail appearance (Kruskal-Wallis test, P < .001). Three-quarters (72.6%) of nails that had more than 67% nail involvement showed statistically significant improvement (chi(2) test, P = .001). Adverse events were limited to mild to moderate pain at the time of therapy. A total of 76 subjects were assessed for treatment satisfaction: 60% were very satisfied with treatment despite limited clinical improvement in some cases. Conclusions: Laser therapy has a very limited positive clinical effect on the appearance of onychomycosis after 2 treatment sessions.